口服卡马西平致重症多形红斑型药疹

Erythema multiforme drug eruption caused by oral carbamazepine

1例44岁女性患者因左肺中央型肺癌(腺癌)、多发脑转移、继发癫痫入院。入院后给予卡马西平0.1 g,每天3次口服;20%甘露醇,奥美拉唑,地塞米松静脉滴注。20 d后患者全身出现散在皮疹、口腔内多发溃疡,经专科会诊初步考虑服用卡马西平引发过敏性药疹。立即停用以上药物,给予依匹斯汀20 mg,每天1次;酮替芬1 mg,每天2次;哈西奈德液、曲咪新乳膏和炉甘石洗剂,每天3次,外用。3 d后,患者症状加重,确诊为重症多形红斑型药疹。在原治疗方案基础上,加用氨曲南1.5 g,阿奇霉素0.5 g,甲泼尼松龙40 mg,每天2次静脉滴注。2周后患者吞咽正常,停用静脉激素,改为口服,一个月后新鲜皮肤长出,口服激素出院。

One 44-year-old female patient with lung cancer,multiple brain metastasis and secondary epilepsy was admitted in hospital.Carbamazepine tablet 0.1 g thrice daily,intravenous 20% mannitol,omeprazole and dexamethasone were administered.After 20 days,the patient developed the scattered rash in skin and ulcer in mouth,which was considered as allergic medicine rash related to carbamazepine.All drugs were withdrawn immediately,and the patient was given epinastine 20 mg once daily,ketotifen 1 mg twice daily and halcinonide liquid,triamcinolone acetonide acetate and miconazole nitrate neomycin sulfate cream and calamine lotion thrice daily for external use.Three days later,her symptoms got severer,and the erythema multiforme drug eruption was diagnosed.The patient was intravenously given aztreonam 1.5 g,azithromycin 0.5 g and methylprednisolone 40 mg twice daily.Two weeks later,the deglutition recovered,and the oral medication of hormone was changed.All the skin and the mucosa recovered in one month later,and the patient discharged from hospital.